Meta-analysis of observational studies of ileorectal <i>versus</i> ileal pouch–anal anastomosis for familial adenomatous polyposis

Aziz, Omer; Athanasiou, Thanos; Fazio, Victor W.; Nicholls, R. J.; Darzi, Ara; Church, James M.; Phillips, R. K. S.; Tekkis, Paris

doi:10.1002/bjs.5276

Cited by 174 publications

(128 citation statements)

References 44 publications

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“…Moreover, the number of self-reported symptoms was the strongest predictor of patients' physical and mental health. As expected, symptoms such as diarrhea, nighttime urge of defecation, and flatus, which were previously reported in patients with FAP after prophylactic colorectal surgery, 3 were frequently reported by patients in the current study. However, symptoms not previously reported, such as borborygmi, abdominal distension, abdominal discomfort or pain relieved by defecation, and belching, were reported by 30% to 62% of our patients.…”

Section: Discussionsupporting

confidence: 90%

“…1,2 Patients with FAP are normally asymptomatic before surgery, but after surgery they report various symptoms, such as an increase in number of bowel movements per day, nighttime defecation, leakage, fecal urgency, difficulty in distinguishing gas from feces, perianal skin problems, and small-bowel obstruction. Most patients also report a need for dietary restrictions 3,4 to avoid disturbing abdominal symptoms. 5 Symptoms have been suggested to be more prevalent in patients with an IPAA than in those with an IRA; 3 knowledge is limited regarding symptoms experienced by patients with an ileostomy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Self-Reported Abdominal Symptoms in Relation to Health Status in Adult Patients With Familial Adenomatous Polyposis

Fritzell

Björk²,

Hultcrantz³

et al. 2011

Diseases of the Colon &Amp; Rectum

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Self-Reported Abdominal Symptoms in Relation to Health Status in Adult Patients With Familial Adenomatous Polyposis

Fritzell

Björk²,

Hultcrantz³

et al. 2011

Diseases of the Colon &Amp; Rectum

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“…In an interesting metanalysis, AZIZ et al (2) compared 12 studies published from 1991 to 2003, reuniting 1,002 patients. The authors found less evacuatory dysfunction after IRA and a greater reoperation rate after RPC (23.4% vs 11.6%).…”

Section: Discussionmentioning

confidence: 99%

“…Since its introduction, RPC has suffered continuous modifications in order to achieve better functional outcome, less morbidity and mucosal disease control. Despite some controversies, RPC progressively turned out to be the gold standard treatment for FAP and ulcerative colitis (2) .…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Campos

Perez

Imperiale

et al. 2009

Arq. Gastroenterol.

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-Context -Controversy regarding the best operative choice for familial adenomatous polyposis lays between the morbidity of restorative proctocolectomy and the supposed mortality due to rectal cancer after ileorectal anastomosis. Objectives -To evaluate operative complications and oncological outcome after ileorectal anastomosis and restorative proctocolectomy. Among the 26 patients followed after restorative proctocolectomy, it was found cancer in the ileal pouch in 1 (3.8%). Conclusions -1. Operative complications occurred in about one third of the patients, being more frequently after the confection of ileal reservoir; 2. greater age and previous colonic carcinoma were associated with the development of rectal cancer after ileorectal anastomosis; 3. patients treated by restorative proctocolectomy are not free from the risk of pouch degeneration; 4. the disease complexity and the various risk factors (clinical, endoscopic, genetic) indicate that the best choice for operative treatment should be based on individual features discussed by a specialist; 5. all patients require continuous and long-term surveillance during postoperative follow-up.

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“…Surgical options include subtotal colectomy with ileorectal anastomosis (IRA), total proctocolectomy with ileostomy, and proctocolectomy with or without mucosectomy and ileal pouch anal anastomosis (IPAA) [75][76][77].…”

Section: Management Of the Fap Patientmentioning

confidence: 99%

Familial Adenomatous Polyposis

2006

Atlas of Genetic Diagnosis and Counseling

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Familial adenomatous polyposis (FAP) is characterized by the development of many tens to thousands of adenomas in the rectum and colon during the second decade of life. FAP has an incidence at birth of about 1/8,300, it manifests equally in both sexes, and accounts for less than 1% of colorectal cancer (CRC) cases. In the European Union, prevalence has been estimated at 1/ 11,300-37,600. Most patients are asymptomatic for years until the adenomas are large and numerous, and cause rectal bleeding or even anemia, or cancer develops. Generally, cancers start to develop a decade after the appearance of the polyps. Nonspecific symptoms may include constipation or diarrhea, abdominal pain, palpable abdominal masses and weight loss. FAP may present with some extraintestinal manifestations such as osteomas, dental abnormalities (unerupted teeth, congenital absence of one or more teeth, supernumerary teeth, dentigerous cysts and odontomas), congenital hypertrophy of the retinal pigment epithelium (CHRPE), desmoid tumors, and extracolonic cancers (thyroid, liver, bile ducts and central nervous system). A less aggressive variant of FAP, attenuated FAP (AFAP), is characterized by fewer colorectal adenomatous polyps (usually 10 to 100), later age of adenoma appearance and a lower cancer risk. Some lesions (skull and mandible osteomas, dental abnormalities, and fibromas on the scalp, shoulders, arms and back) are indicative of the Gardner variant of FAP. Classic FAP is inherited in an autosomal dominant manner and results from a germline mutation in the adenomatous polyposis (APC) gene. Most patients (~70%) have a family history of colorectal polyps and cancer. In a subset of individuals, a MUTYH mutation causes a recessively inherited polyposis condition, MUTYH-associated polyposis (MAP), which is characterized by a slightly increased risk of developing CRC and polyps/adenomas in both the upper and lower gastrointestinal tract. Diagnosis is based on a suggestive family history, clinical findings, and large bowel endoscopy or full colonoscopy. Whenever possible, the clinical diagnosis should be confirmed by genetic testing. When the APC mutation in the family has been identified, genetic testing of all first-degree relatives should be performed. Presymptomatic and prenatal (amniocentesis and chorionic villous sampling), and even preimplantation genetic testing is possible. Referral to a geneticist or genetic counselor is mandatory. Differential diagnoses include other disorders causing multiple polyps (such as Peutz-Jeghers syndrome, familial juvenile polyps or hyperplastic polyposis, hereditary mixed polyposis syndromes, and Lynch syndrome). Cancer prevention and maintaining a good quality of life are the main goals of management and regular and systematic follow-up and supportive care should be offered to all patients. By the late teens or early twenties, colorectal cancer prophylactic surgery is advocated. The recommended alternatives are total proctocolectomy and ileoanal pouch or ileorectal anastomosis for AFAP. ...

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Meta-analysis of observational studies of ileorectal versus ileal pouch–anal anastomosis for familial adenomatous polyposis

Abstract: Ileal pouch and ileorectal anastomoses have individual merits. Further research is needed to determine which most benefits patients with FAP.

Cited by 174 publications

References 44 publications

Self-Reported Abdominal Symptoms in Relation to Health Status in Adult Patients With Familial Adenomatous Polyposis

Self-Reported Abdominal Symptoms in Relation to Health Status in Adult Patients With Familial Adenomatous Polyposis

Surgical treatment of familial adenomatous polyposis: ileoretal anastomosis or restorative proctolectomy?

Familial Adenomatous Polyposis

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